Ear Infections in Children: Causes & Treatment

Girl having her ear covered by her mother

Pain, intense itching and redness in or around the ears could be a sign of infection. Viruses and bacteria, the two main causes of infections, get trapped somewhere between the ear canal and eardrum. Over time, the viruses and bacteria can cause inflammation, irritation and swelling that causes your child to experience pain and discomfort.

Types of Ear Infections in Children

Ear infections are extremely common in children. In fact, approximately 75% of children will suffer from at least one ear infection before their first birthday¹.

The type of infection your child has will be determined by what part of the ear is affected. Middle ear infections, or otitis media, and outer ear infections, sometimes referred to as otitis externa or swimmer’s ear, are the two most common types of ear infections².

What are Middle Ear Infections?
There is a small space in the middle of the ear canal right behind the eardrum. If bacteria or viruses get trapped inside this small space, they can cause an infection to develop. The infection causes pus to form in the small space behind the eardrum. Eventually, so much pus is created that it starts to push against the eardrum which can cause intense pain³.
What are Outer Ear Infections?
Outer ear infections develop in the narrow canal that connects the outer ear to the middle ear. This canal helps carry sound from outside the body to the eardrum. If debris, such as dirt, sand or water, combines with other germs stuck in the narrow ear canal an infection can develop⁴.

Outer Ear Infections (Swimmer’s Ear) in Children

Outer ear infections can happen to anyone. However, it is most common amongst children⁵. Children are at a higher risk for outer ear infections because of the size of their ear canal. Children’s ear canals tend to be extremely narrow. Small, narrow ear canals are more likely to get water or other types of debris trapped inside. If bacteria, fungi or viruses enter the dark, moist ear canal, the conditions are just right for them to rapidly grow and spread, which results in the development of an infection.

Children who regularly take part in swimming are at risk for developing outer ear infections. The water from the pool or ocean enters the ear canal and gets trapped. If the water isn’t removed, the moist conditions encourage bacteria and other organisms to grow⁶.

How Can I Tell if My Child Has an Ear Infection?

Very specific behaviors and actions often indicate that your child could be suffering from an ear infection. The following are some of the most common signs of ear infection in children⁷:

Itchy feeling inside the ear canal
Pain when the ear is tugged
Redness
Swelling or tenderness around the ear
Drainage that directly comes from the ear
Excessive tugging or pulling at the ears

Some ear infections are asymptomatic. This means that the infection could be present, but your child is not experiencing any symptoms.

What Causes Outer Ear Infections (Swimmer’s Ear/Otitis Externa)?

Outer ear infections, known as otitis externa or swimmer’s ear, occur when excessive moisture enters the ear canal. The ear canal is dark, moist and narrow which are perfect conditions for bacteria to grow and spread. If bacteria enters the canal, an infection can quickly develop⁸.

While 98% of all acute cases of outer ear infection are caused by bacteria other organisms can cause infections⁹. Other organisms that can cause outer ear infections include yeast, fungi and viruses.

Outer ear infections can happen at any time of the year. However, it seems as if these types of infections occur more frequently during the summer months. Outer ear infections are most common during the summer because children are more likely to be swimming.

The type of swimming children engage in during the summer months can also contribute to the increase in outer ear infections. During the summer months, children are more likely to swim in ponds, lakes and oceans, where the bacteria levels are high. Swimming in chlorinated water will reduce your child’s risk of getting an outer ear infection¹⁰.

Signs and Symptoms of Swimmer’s Ear

Even though swimmer’s ear is an infection, most children do not develop a fever. There are very specific and noticeable signs and symptoms that occur when your child develops an outer ear infection.

The most common signs and symptoms of swimmer’s ear include: ¹¹

Complaints of hearing loss or feeling as if sound is muffled or muted
Constant tugging or pulling at the ears
Ears appear bright red and are often tender to touch
Lymph nodes may feel swollen
Discharge may come from the ear canal – discharge is usually clear but it can also have a cloudy, milky white or yellow tint to it.

How Long Do Ear Infections Last in Children?

Ear infections, if properly diagnosed by a medical professional in a timely manner, can resolve be resolved in approximately 7 to 10 days. Acute cases of ear infections may take longer to clear up.

Even if the infection goes away children can still experience some symptoms such as hearing loss for several months¹². If symptoms last for more than three months, a second trip to the doctor may be needed. A second visit to the doctor may also be needed if your child’s symptoms get worse or if they reappear.

Treating Swimmer’s Ear (Otitis Externa) in Children

The Canadian Pediatric Society recommends that doctors take a watch and wait approach to treating ear infections in children over the age of six months. However, the severity of the symptoms your child is experiencing combined with the cause of the infection will determine what, if any, treatment is prescribed¹³.

It is highly recommended that you visit a doctor if you suspect your child has an ear infection. A doctor will assess the situation and determine what treatment is best for your child’s unique situation.

Treatment of swimmer’s ear in children is focused on providing pain relief¹⁴. To help your child with pain, their doctor may recommend taking over-the-counter pain medication or using antibiotic ear drops like POLYSPORIN^® Plus Pain Relief Ear Drops. Placing a warm washcloth or heating pad near the ear can also help relieve pain caused by swimmer’s ear.

Antibiotics, which are commonly prescribed to treat infections, aren’t commonly used for outer ear infections. Some doctors prefer the watch and wait approach because other treatment options, such as over-the-counter pain medication and ear drops, can provide immediate pain relief¹⁵.

Antibiotics may be prescribed if your child has any of the following¹⁶:

Cochlear implants
Other health problems such as autoimmune diseases, history of repeated infections or a cleft palate
Severe symptoms, such as intense pain, fever, nausea, vomiting or dehydration, that may be caused by the infection

Tips for Preventing Swimmer’s Ear

There is no way to completely prevent swimmer’s ear. However, there are some things you can do which will reduce your risk of developing an outer ear infection.

The following are some preventative tips that can help you reduce your child’s risk of developing swimmer’s ear¹⁷:

Completely dry ears after swimming, baths and showers – gently wipe the outer ear with a towel to remove excessive moisture from the ear.
Use a hair dryer to remove hard-to-remove water from the ear canal – setting a hair dryer on the lowest setting and holding it near the ear can help dry up any excessive water that you weren’t able to reach with a towel.
Avoid swimming in ponds or lakes that are known to have high levels of bacteria
Wear earplugs while swimming – make sure the earplugs fit properly. If the earplugs are too big or too small, water can enter the ear canal and cause infection.
Avoid using small object to scratch or itch the inside of your ear – these small objects can cause damage to the ear canal which can become infected if it comes into contact with bacteria or fungi.

Ear infections, especially outer ear infections, are extremely common in children. You may not be able to completely prevent ear infections from happening, but you can reduce your child's risk of developing them by learning about what causes ear infection in children and what you can do to prevent them.

While some ear infections are asymptomatic, most cause visible signs and symptoms that indicate an infection is present. Excessive tugging of the ears, problems with hearing and pain, swelling or tenderness around the ear are all common symptoms of ear infections in children.

Treatment for ear infections varies from person to person. It is important to visit a doctor, especially if your child is under the age of six, if you notice any signs of an ear infection. A doctor will determine the best treatment, whether it be over-the-counter pain relievers, antibiotic ear drops like POLYSPORIN^® Plus Pain Relief Ear Drops, or an oral antibiotic, for your child’s ear infection.

Ear Infections in Children: Causes & Treatment

Types of Ear Infections in Children

What are Middle Ear Infections?

What are Outer Ear Infections?